In the Hands of Doctors: Touch and Trust in Medical Care

Written by a highly respected medical historian, this book examines how and why medical caring―including the role of touch and procedure in caregiving―has evolved in recent decades and how these changes have affected doctor-patient trust as well as patient health and the "health" of the current medical system.
Why is it that, despite the curative wonders of modern medicine, we still feel frustrated by doctors who lack the time and inclination really to care for us, much less care about us? In this book, Paul Stepansky explores this paradox through a historical examination of medical care that stretches back to the 19th century but focuses on the decades since the end of World War II. The reasons contemporary doctors find it difficult to care for their patients in the manner of the postwar generation are varied and range beyond the press of 15-minute office visits. They begin with medical education and its "hidden curriculum" and include the questionable manner in which medical educators approach the teaching of empathy. In the realm of practice, they include the disinclination of many primary care doctors to perform office procedures that put them in touch, literally, with their patients' bodies. And finally, there is social media, especially Facebook and patient satisfaction surveys, which have altered doctor-patient relationships in fundamental ways.
Stepansky's comparative historical approach traverses a number of interrelated topics: the role of procedural medicine in caring; the nature and goals of medical education; 19th-century approaches to cultivating caring doctors; and the changing meanings of friendship between doctor and patient. He explains the human dimension of medical technologies, old and new, and the different kinds of "touch" that enter into medical and nursing care. And then he brings his analysis to bear on the serious shortage of primary care physicians in the United States, considering along the way the rise and fall of the "family practice" specialty in America and the expanded role of nurse practitioners and physician assistants in primary care.
Weaving into his discussion an astute appreciation of the Patient Protection and Affordable Care Act of 2010 and the new health care delivery systems it promotes, Stepansky concludes by offering innovative proposals for revitalizing primary care medicine and strengthening the trust between doctors and the patients who rely on them.

• Draws on medical history since the early 19th century to demonstrate how the procedural aspects of medicine are foundational to trusting doctor-patient relationships
• Examines how the diminished authority of physicians as decision makers and consumerization of medical services have complicated caregiving
• Provides concrete proposals for reinvigorating primary care medicine by developing a new primary care specialty and making better use of nurse practitioners and other nonphysician providers